小剂量盐酸替罗非班联合PCI对非ST段抬高型急性冠脉综合征患者生化指标、心功能指标及不良反应的影响
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摘要
目的探究小剂量盐酸替罗非班联合经皮冠状动脉介入治疗(PCI)对非ST段抬高型急性冠脉综合征(NSTE-ACS)患者生化指标、心功能指标及不良反应的影响。方法按照随机数字表法将134例拟行PCI治疗的NSTE-ACS患者分为观察组及对照组,两组患者均给予常规阿司匹林联合氯吡格雷抗凝,观察组在此基础上加用小剂量盐酸替罗非班。测定两组患者手术前后TIMI血流灌注、左室射血分数(EF)、左室舒张末期内径(LVEDD)、左室收缩末期内径(LVESD)等心功能指标及血清肌钙蛋白I(cTnl)、C反应蛋白(CRP)等生化指标,记录两组患者心血管事件发生情况及不良反应。结果两组患者术后血流TIMI分级、EF、LVESD、LVEDD均显著改善,观察组显著优于对照组(P<0.05);术后两组患者血清cTnI、CRP水平上升,术后观察组血清CRP水平低于对照组(P <0. 05);观察组及对照组不良心血管事件发生率分别为1.49%、10.45%,但两者比较差异无统计学意义(P>0.05);两组均无严重不良反应发生。结论小剂量盐酸替罗非班可改善NSTE-ACS患者PCI术后血流状态,改善血管炎症,促进术后心功能恢复。
Objective To investigate the effects of low-dose tirofiban hydrochloride combined with percutaneous coronary intervention(PCI) on biochemical indicators, cardiac function indexes and adverse reactions in patients with non-ST-segment elevation acute coronary syndrome(NSTE-ACS). Methods 134 patients with NSTE-ACS who were planned to be treated with PCI were divided into the observation group and the control group by the random number table method. Both groups were given routine aspirin combined with clopidogrel anticoagulation. In addition, the observation group was treated with low-dose tirofiban hydrochloride. Cardiac function indexes such as TIMI blood perfusion,left ventricular ejection fraction(EF),left ventricular end-diastolic diameter( LVEDD) and left ventricular end-systolic diameter( LVESD),biochemical indicators such as serum troponin I(cTnI) and C-reactive protein(CRP) in both groups were measured before and after the operation. The incidence of cardiovascular events and adverse reactions in both groups were recorded. Results The postoperative TIMI grade of blood flow,EF,LVESD and LVEDD in both groups were significantly improved after the operation, and the above indexes in the observation group were significantly better than those in the control group(P <0.05). The serum cTnI and CRP levels in both groups were increased after the operation, and the CRP level in the observation group was lower than that in the control group(P <0. 05). The incidence rates of adverse cardiovascular events in the observation group and the control group were 1.49% and 10.45%,respectively(P >0.05). No serious adverse reactions occurred in either group. Conclusion Low-dose tirofiban hydrochloride can improve blood flow in patients with NSTEACS after PCI,relieve vascular inflammation and promote postoperative cardiac function recovery.
Objective To investigate the effects of low-dose tirofiban hydrochloride combined with percutaneous coronary intervention(PCI) on biochemical indicators, cardiac function indexes and adverse reactions in patients with non-ST-segment elevation acute coronary syndrome(NSTE-ACS). Methods 134 patients with NSTE-ACS who were planned to be treated with PCI were divided into the observation group and the control group by the random number table method. Both groups were given routine aspirin combined with clopidogrel anticoagulation. In addition, the observation group was treated with low-dose tirofiban hydrochloride. Cardiac function indexes such as TIMI blood perfusion,left ventricular ejection fraction(EF),left ventricular end-diastolic diameter( LVEDD) and left ventricular end-systolic diameter( LVESD),biochemical indicators such as serum troponin I(cTnI) and C-reactive protein(CRP) in both groups were measured before and after the operation. The incidence of cardiovascular events and adverse reactions in both groups were recorded. Results The postoperative TIMI grade of blood flow,EF,LVESD and LVEDD in both groups were significantly improved after the operation, and the above indexes in the observation group were significantly better than those in the control group(P <0.05). The serum cTnI and CRP levels in both groups were increased after the operation, and the CRP level in the observation group was lower than that in the control group(P <0. 05). The incidence rates of adverse cardiovascular events in the observation group and the control group were 1.49% and 10.45%,respectively(P >0.05). No serious adverse reactions occurred in either group. Conclusion Low-dose tirofiban hydrochloride can improve blood flow in patients with NSTEACS after PCI,relieve vascular inflammation and promote postoperative cardiac function recovery.
引文
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[8] QADIR M I, REHMAN A, HAMIDAKASH M S, et al. Short Communication:Evaluation of nephrotoxicity by aspirin-clopidogrel combination therapy in patients with acute coronary syndrome.[J].Pak J Pharm Sci,2016,29(6):2103-2104.
[9]寇玲,傅思惟,刘建根,等.不同剂量盐酸替罗非班联合PCI治疗老年急性冠脉综合征合并糖尿病患者的有效性与安全性[J].中国老年学杂志,2014,34(3):579-581.
[10]杨建军,庞小华,张建明,等.瑞舒伐他汀联合替罗非班对急性冠状动脉综合征并发糖尿病患者PCI术后血清炎症因子水平和肾功能的影响[J].中国药房,2018,29(5):679-683.
[11]王媛.直接PCI联合盐酸替罗非班对老年STEMI合并糖尿病病人心功能的影响[J].中西医结合心脑血管病杂志,2017,15(13):4668-4670.
[12]杜蕊,张冬梅,李颖,等.替罗非班对急性ST段抬高型心肌梗死介人治疗的临床研究[J].中国临床药理学杂志,2016,32(13):1162-1165.
[13] TURKMEN S,FETTSER D V, KAGLIIAN K E, et al. Effect of intracoronary and intravenous administration of tirofiban loading dose in patients underwent percutaneous coronary interventions because of acute coronary syndrome[J]. Kardiologiia,2013,53(1):23-27.
[14]张会军,王安杏,仇卫锋,等.替罗非班对急性STEMI患者行PCI治疗远期预后的影响[J].中国循证心血管医学杂志,2017,9(1):56-59.
[15]段朝龙,仇卫锋,栾荣华.术前应用替罗非班对中、高危急性非ST段抬高型心肌梗死行急诊PCI术患者的临床研究[J].陕西医学杂志,2012,41(8):962-964.
[16]刘影,龙琴,肖维雷,等.高敏肌钙蛋白I、肌酸激酶同工酶及超敏C-反应蛋白在急性心肌梗死诊断中的价值分析[J].标记免疫分析与临床,2016,23(3):288-290.
[17]任广理,罗涛,侯伯轩,等.血浆炎症细胞因子与急性冠脉综合征的相关性研究[J].中国循证心血管医学杂志,2017,9(3):360-364.
[18]尚艳菲.半负荷量替罗非班对急性ST抬高型心肌梗死患者急诊PCI术后hs-CRP与NT-proBNP及预后的影响[J].河北医药,2016,38(24):3731-3733.
[19] AZAR R R,BADAOUI G,SARKIS A,et al. Effects of tirofiban and statins on high-sensitivity C-reactive protein, interleukin-6, and soluble CD40 ligand following percutaneous coronary interventions in patients with stable coronary artery disease[J]. Am J Cardiol,2005,95(2):236-240.
[20]陈自翔.替罗非班对急性心肌梗死患者PCI术后肌钙蛋白、脑钠肽及心功能的影响[J].海南医学院学报,2017,23(2):248-250.
[2]王建锋,周国伟,张国兵,等.经皮冠状动脉介人治疗左主干病变所致的急性心肌梗死临床分析[J].中国循环杂志,2016,31(10):962-965.
[3]赵烨婧,彭红玉,秦宇君,等.经皮冠状动脉介人治疗术后不同剂量依诺肝素联合替格瑞洛对复杂冠状动脉病变的非ST段抬高型急性冠状动脉综合征患者临床事件的影响[J].中国介入心脏病学杂志,2018,26(3):129-136.
[4]刘占伟.血栓通联合阿司匹林对冠心病患者介入术后血清超敏C反应蛋白、血管内皮生长因子水平的影响[J].实用临床医药杂志,2017,21(11):151-153.
[5]戴征,刘新峰.替罗非班治疗急性缺血性卒中的应用进展[J].中国脑血管病杂志,2017,14(10):22-24.
[6] VENTURA A J R, REQUENA R S, MARTI-BONMATI L, et al.The heterogeneity of blood flow on magnetic resonance imaging:A biomarker for grading cerebral astrocytomas[J].Radiologia, 2014,56(4):328-338.
[7]郭力鹏,梁滨,许青宗.氯吡格雷与替格瑞洛对经皮冠状动脉介人治疗术后患者凝血功能及心脑血管的影响[J].检验医学与临床,2018,15(5):66-67.
[8] QADIR M I, REHMAN A, HAMIDAKASH M S, et al. Short Communication:Evaluation of nephrotoxicity by aspirin-clopidogrel combination therapy in patients with acute coronary syndrome.[J].Pak J Pharm Sci,2016,29(6):2103-2104.
[9]寇玲,傅思惟,刘建根,等.不同剂量盐酸替罗非班联合PCI治疗老年急性冠脉综合征合并糖尿病患者的有效性与安全性[J].中国老年学杂志,2014,34(3):579-581.
[10]杨建军,庞小华,张建明,等.瑞舒伐他汀联合替罗非班对急性冠状动脉综合征并发糖尿病患者PCI术后血清炎症因子水平和肾功能的影响[J].中国药房,2018,29(5):679-683.
[11]王媛.直接PCI联合盐酸替罗非班对老年STEMI合并糖尿病病人心功能的影响[J].中西医结合心脑血管病杂志,2017,15(13):4668-4670.
[12]杜蕊,张冬梅,李颖,等.替罗非班对急性ST段抬高型心肌梗死介人治疗的临床研究[J].中国临床药理学杂志,2016,32(13):1162-1165.
[13] TURKMEN S,FETTSER D V, KAGLIIAN K E, et al. Effect of intracoronary and intravenous administration of tirofiban loading dose in patients underwent percutaneous coronary interventions because of acute coronary syndrome[J]. Kardiologiia,2013,53(1):23-27.
[14]张会军,王安杏,仇卫锋,等.替罗非班对急性STEMI患者行PCI治疗远期预后的影响[J].中国循证心血管医学杂志,2017,9(1):56-59.
[15]段朝龙,仇卫锋,栾荣华.术前应用替罗非班对中、高危急性非ST段抬高型心肌梗死行急诊PCI术患者的临床研究[J].陕西医学杂志,2012,41(8):962-964.
[16]刘影,龙琴,肖维雷,等.高敏肌钙蛋白I、肌酸激酶同工酶及超敏C-反应蛋白在急性心肌梗死诊断中的价值分析[J].标记免疫分析与临床,2016,23(3):288-290.
[17]任广理,罗涛,侯伯轩,等.血浆炎症细胞因子与急性冠脉综合征的相关性研究[J].中国循证心血管医学杂志,2017,9(3):360-364.
[18]尚艳菲.半负荷量替罗非班对急性ST抬高型心肌梗死患者急诊PCI术后hs-CRP与NT-proBNP及预后的影响[J].河北医药,2016,38(24):3731-3733.
[19] AZAR R R,BADAOUI G,SARKIS A,et al. Effects of tirofiban and statins on high-sensitivity C-reactive protein, interleukin-6, and soluble CD40 ligand following percutaneous coronary interventions in patients with stable coronary artery disease[J]. Am J Cardiol,2005,95(2):236-240.
[20]陈自翔.替罗非班对急性心肌梗死患者PCI术后肌钙蛋白、脑钠肽及心功能的影响[J].海南医学院学报,2017,23(2):248-250.